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INTRODUCTION

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estazolam (es-taz-oh-lam)

ProSom

Classification

Therapeutic: sedative/hypnotics

Pharmacologic: benzodiazepines

Schedule IV

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Indications
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Short-term management of insomnia.

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Action
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Depresses the CNS, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Relief of insomnia.

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Adverse Reactions/Side Effects
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CNS: abnormal thinking, behavior changes, drowsiness, hallucinations, headache, weakness, abnormal dreams, sleep-driving, confusion, depression, dizziness, hangover, malaise, nervousness. Resp: cold symptoms, pharyngitis. CV: chest pain. GI: abdominal pain, dyspepsia, nausea. MS: back pain, lower extremity pain, stiffness. Neuro: abnormal coordination, hypokinesia. Misc: body pain, physical dependence, psychologic dependence.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor daytime drowsiness, short-term memory deficits, and, “hangover” symptoms (headache, nausea, malaise, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

  • Be alert for confusion, depression, nervousness, abnormal thoughts, hallucinations, or other alterations in cognitive function (See Appendix D). Notify physician promptly if these symptoms develop.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Report any coordination problems or decreased bodily movements (hypokinesia) that are consistent with onset of drug therapy or changes in drug dose.

  • Assess any back pain, lower extremity pain, weakness, or stiffness to rule out musculoskeletal pathology; that is, try to determine if symptoms are drug induced rather than caused by anatomic or biomechanical problems.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (see Appendix E).

  • Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoidance of caffeine, and so forth.

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Patient/Client-Related Instruction
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  • Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and increased sleep problems (rebound insomnia) can occur when the drug is suddenly discontinued.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Caution patient and family/caregivers to guard against complex motor behaviors that can occur while asleep, including driving a car.

  • Instruct patient to report other bothersome side effects, including severe or prolonged headache, cold symptoms, irritation of the throat and pharynx, chest pain, or GI problems (nausea, abdominal pain, indigestion).

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Pharmacokinetics
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Absorption: Well absorbed following oral administration.

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Distribution: Highly lipid soluble. Crosses the blood-brain barrier and placenta; enters breast milk.

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Protein Binding: 93%.

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Metabolism and Excretion: Mostly metabolized by the liver; metabolites do ...

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